There is no body cavity that cannot be reached with a number fourteen needle and a good strong arm.
Preoperative and postoperative X-ray of a person with thoracic dextroscoliosis and lumbar levoscoliosis: The X-ray is usually projected such that the right side of the subject is on the right side of the image; i.e., the subject is viewed from the rear (see top image; the bottom image is seen from the front). This projection is typically used by spine surgeons, as it is how surgeons see their patients when they are on the operating table (in the prone position). This is the opposite of conventional chest X-ray, where the image is projected as if looking at the patient from the front. The surgery was a fusion and instrumentation.
References to hydrocephalic skulls can be found in ancient Egyptian medical literature from 2500 BC to 500 AD. Hydrocephalus was described more clearly by the ancient Greek physician Hippocrates in the 4th century BC, while a more accurate description was later given by the Roman physician Galen in the 2nd century AD. The first clinical description of an operative procedure for hydrocephalus appears in the Al-Tasrif (1000 AD) by the Arab surgeon, Abulcasis, who clearly described the evacuation of superficial intracranial fluid in hydrocephalic children. He described it in his chapter on neurosurgical disease, describing infantile hydrocephalus as being caused by mechanical compression. He states:
“The skull of a newborn baby is often full of liquid, either because the matron has compressed it excessively or for other, unknown reasons. The volume of the skull then increases daily, so that the bones of the skull fail to close. In this case, we must open the middle of the skull in three places, make the liquid flow out, then close the wound and tighten the skull with a bandage.”
In 1881, a few years after the landmark study of Retzius and Key, Carl Wernicke pioneered sterile ventricular puncture and external CSF drainage for the treatment of hydrocephalus. It remained an intractable condition until the 20th century, when shunts and other neurosurgical treatment modalities were developed. It is a lesser-known medical condition; relatively small amounts of research are conducted to improve treatments for hydrocephalus, and to this day there remains no cure for the condition. In developing countries, it is common that this condition go untreated at birth. It is difficult to diagnose during ante-natal care and access to medical treatment is limited. However, when head swelling is prominent, children are taken at great expense for treatment. By then, brain tissue is undeveloped and neurosurgery is rare and difficult.
Hydrocephalus is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, tunnel vision, and mental disability. Hydrocephalus can also cause death. Although it does occur in older adults, it is more common in infants.
Image: Hydrocephalus seen on a CT scan of the brain
When Ian Burkhart was 19, he accidentally dove into a sandbar while in the water with friends and quickly realized what had happened: He was paralyzed. Today, Burkhart is still paralyzed—but he can move his hand by controlling it with his mind.
Warfarin is an anticoagulant normally used in the prevention of thrombosis and thromboembolism, the formation of blood clots in the blood vessels and their migration elsewhere in the body respectively. It was initially introduced in 1948 as a pesticide against rats and mice and is still used for this purpos. In the early 1950s, warfarin was found to be effective and relatively safe for preventing thrombosis and thromboembolism in many disorders. It was approved for use as a medication in 1954 and has remained popular ever since; warfarin is the most widely prescribed oral anticoagulant drug in North America.
If the placebo works as well as the active drug, we could perhaps take them the way we take pills today, perhaps even knowing they were fake. Several studies have shown placebos working even when patients knew what was happening.
Chiari malformation is a malformation of the brain. It consists of a downward displacement of the cerebellar tonsils through the foramen magnum (the opening at the base of the skull), sometimes causing non-communicating hydrocephalus as a result of obstruction of cerebrospinal fluid (CSF) outflow. The cerebrospinal fluid outflow is caused by phase difference in outflow and influx of blood in the vasculature of the brain. It can cause headaches, fatigue, muscle weakness in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis.
Image: A T1-weighted sagittal MRI scan, from a patient with an Arnold-Chiari malformation, demonstrating tonsillar herniation of 7mm
"Usually it was the Western music they wanted to copy," Sergei Khrushchev, the son of Joseph Stalin’s successor as the U.S.S.R.’s General Secretary explained to NPR. "Before the tape recorders they used the X-ray film of bones and recorded music on the bones, bone music."
First do no harm.
Arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three membranes that cover the brain and the spinal cord. Arachnoid cysts are a congenital disorder, and most cases begin during infancy; however, onset may be delayed until adolescence.
Image: An MRI of a 25 year old woman with left frontotemporal arachnoid cyst.
At a cardiac arrest, the first procedure is to take your own pulse
The ependyma is made up of ependymal cells, ependymocytes. These epithelial-like cells line the CSF-filled ventricles in the brain and the central canal of the spinal cord. The cells are ciliated simple cuboidal epithelium-like cells. Their apical surfaces are covered in a layer of cilia, which circulate CSF around the CNS. Their apical surfaces are also covered with microvilli, which absorb CSF. Ependymal cells are a type of glial cell and are also CSF producing cells. Within the ventricles of the brain, a population of modified ependymal cells and capillaries together form a system called the choroid plexus, which produces the CSF.
Modified tight junctions between ependymal cells control fluid release across the epithelium. This release allows free exchange between CSF and nervous tissue of brain and spinal cord. This is why sampling of CSF (e.g. through a “spinal tap”) gives one a window to the CNS.
Image: Photomicrograph of hematoxylin stained section of normal ependymal cells at 400x magnification.